Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China.
Department of Medicine, Englewood Hospital, Englewood, NJ, USA.
Pediatr Radiol. 2022 Jul;52(8):1559-1567. doi: 10.1007/s00247-022-05344-4. Epub 2022 Mar 31.
Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the common causes of neurological injury in full-term neonates following perinatal asphyxia. The conventional magnetic resonance technique has low sensitivity in detecting variations in cerebral blood flow in patients with HIE.
This article evaluates the clinical diagnostic value of three-dimensional pseudo-continuous arterial spin labelling (3-D pcASL) perfusion magnetic resonance imaging (MRI) for early prediction of neurobehavioral outcomes in full-term neonates with HIE.
All neonates diagnosed with HIE underwent MRI (conventional and 3-D pcASL perfusion MRI). Cerebral blood flow values were measured in the basal ganglia (caudate nuclei, lenticular nuclei), thalami and white matter regions (frontal lobes, corona radiata). After 1-month follow-up, the Neonatal Behavioral Neurological Assessment scores were used to divide patients into favourable outcome group versus adverse outcome group.
Twenty-three patients were enrolled in this study. There were no statistical differences between the symmetrical cerebral blood flow values of bilateral basal ganglia, thalami and white matter regions. However, the cerebral blood flow values of grey matter nuclei were higher than the white matter regions. The average value of cerebral blood flow in the basal ganglia and thalami in the adverse outcome group was 37.28±6.42 ml/100 g/min, which is greater than the favourable outcome group (22.55 ± 3.21 ml/100 g/min) (P<0.01). The area under the curve (AUC) of 3-D pcASL perfusion MRI was 0.992 with a cutoff value of 28.75 ml/100 g/min, with a Youden's index of 0.9231. The sensitivity and specificity were 92.3% and 100%, respectively.
The 3-D pcASL demonstrated higher perfusion alteration in the basal ganglia and thalami of neonatal HIE with adverse outcomes. The 3-D pcASL perfusion MRI has the potential to predict neurobehavioral outcomes of neonates with HIE.
新生儿缺氧缺血性脑病（HIE）是围产期窒息后足月新生儿常见的神经损伤原因之一。传统的磁共振技术在检测 HIE 患者脑血流变化方面灵敏度较低。
本研究评估三维伪连续动脉自旋标记（3-D pcASL）灌注磁共振成像（MRI）对 HIE 足月新生儿神经行为结局的早期预测的临床诊断价值。
所有诊断为 HIE 的新生儿均行 MRI（常规及 3-D pcASL 灌注 MRI）检查。测量基底节（尾状核、豆状核）、丘脑和脑白质区（额区、放射冠）的脑血流值。1 个月后随访，采用新生儿行为神经评定量表（NBNA）评分将患儿分为预后良好组和预后不良组。
本研究共纳入 23 例患儿。双侧基底节、丘脑和脑白质区的对称脑血流值无统计学差异，但灰质核团的脑血流值高于脑白质区。预后不良组基底节和丘脑的平均脑血流值为 37.28±6.42ml/100g/min，大于预后良好组（22.55 ± 3.21ml/100g/min）（P<0.01）。3-D pcASL 灌注 MRI 的曲线下面积（AUC）为 0.992，截断值为 28.75ml/100g/min，Youden 指数为 0.9231。其灵敏度和特异度分别为 92.3%和 100%。
3-D pcASL 显示不良结局的新生儿 HIE 基底节和丘脑的灌注改变更高。3-D pcASL 灌注 MRI 有可能预测 HIE 新生儿的神经行为结局。
